Norfolk science lecture looks at ethical challenges

Caring for sick and premature babies is often a balance between what is medically possible and what is ethically acceptable, explained Dr Amanda Ogilvy-Stuart at a recent Science and Faith in Norfolk event.

Event report by Patrick Richmond and Nick Brewin

Dr Amanda Ogilvy-Stuart is a neonatal consultant from Cambridge and she spoke on this emotionally charged subject at a recent meeting organised by Science and Faith in Norfolk.

The number of babies born before 28 weeks of pregnancy has stayed relatively constant for the last 40 years, but there have been significant improvements in their treatment. Now, most premature babies survive and around a third have no long-term disability. This can mean that some babies can now survive outside the womb when their destruction in the womb would be legal, but abortion ethics are a different topic from the ethics relating to neonatal babies.

Doctors try to act with a genuine compassion for the well-being of the child and the parents. But should they resuscitate extremely sick babies, even when there is the strong prospect of severe and permanent disability? At what point should intensive medical support be replaced by palliative care or active euthanasia to end all suffering quickly and painlessly?

As a basis for ethics, Dr Ogilvy-Stuart noted that there was considerable variation in attitudes to unwanted babies throughout history and in different traditions and legal jurisdictions.

In some civilisations, such as that of Ancient Greece, babies and children were considered to have little intrinsic worth. Philosophers like Plato and Aristotle recognised their potential value in terms of their future virtue and physical contribution to society, but infanticide was culturally acceptable. In these societies, babies that were weak or deformed (or even merely female!) were often abandoned and left to die.

By contrast, the Judeo-Christian tradition has taught that human life is sacred and must be protected and cared for. The purpose of human life is the development of loving relationships. This is particularly relevant to the care of the weak and vulnerable.

Christian values pervade much of European culture and have been fundamental to the development of medical ethics. However, there are ethicists, like Peter Singer, who reject the tradition of the sanctity of human life. They argue that babies are not full members of the human community and, in certain circumstances, it can be more compassionate and moral to kill them painlessly than to give them treatment or palliative care. In Holland, active euthanasia of new-borns with very poor prognosis is now legal.

Dr Ogilvy-Stuart explained how neonatal medicine is guided and constrained by a strict code of ethics and legal guidelines. Despite review, the law in the UK does not allow active euthanasia after birth, although it does allow late abortions in the case of fetal abnormality. There is general agreement that human life should not be prolonged by intensive care when there is no prospect of long-term survival or no capacity for loving relationship. In less clear-cut situations, the burden of treatment must be balanced by the benefits in terms of likely quantity and quality of life and no unnecessary interventions should be made. Christian medical ethicist John Wyatt argues that in this context we cannot withdraw life-support because life is not worth living but because the treatment is not worth giving. The withdrawal of life-sustaining treatment is not equivalent to intentional ending of life, and tender, loving care continues to the end.

At the individual level, each sick baby must be carefully managed by clinicians in close liaison with the parents and family. Where appropriate, the family are supported by counsellors and chaplains of the appropriate faith community and this can often help to reach a consensus about what is in the best interests of the child. Where there is a difficult decision about whether to start or withdraw life-sustaining treatment or to offer palliative care, there can be an appropriate religious ceremony and the fostering of cherished memories. As noted by Dame Cicely Saunders, Christian, nurse, physician and founder of the hospice movement (1918 – 2005), “How people die remains in the memories of those who live on”.

Dr Ogilvy-Stuart’s talk led to a lively discussion in which everyone recognised the delicacy and complexity of these extremely personal issues. Sometimes, as in the case of Charlie Gard, these dilemmas suddenly become very public. Many doctors and nurses are motivated by their Christian calling. They try to use their gifts, training and resources to make clinical decisions that are based on the wisdom of a biblical perspective.

Science and Faith in Norfolk (SFN), is a Norwich-based group aiming to explore the interface between science and religious belief. The next meeting of this kind will be on Monday 6th March when Dr Ruth Bancewicz will talk on “God in the Science Lab: curiosity, awe and the meaning of life”. For further information contact Professor Nick Brewin (07901 884114); sfnorfolk1@gmail.com.